There are many different nail problems I see here at Advanced Skin Care and Dermatology Physicians. Nails are fascinating because, in some cases, they can be a window into what’s going on in your body. Here is a list of nail findings that can be a sign of underlying disease.
1. Transverse lines (Beau’s lines)
One of the most common nail findings I see in practice are horizontal indentations in the nails. This can happen because of trauma or because of an illness. If you’ve suffered from a severe illness, your nails temporarily stop growing. After all, when you’re sick, your body needs to put all of its energy into healing. Because it takes 6 months for your nails to completely grow out, you won’t notice a Beau’s line until 3 months after you’ve been sick.
This issue is ice-pick looking depressions in the nails, which can be a sign of multiple problems. The most common problem associated with nail pitting is psoriasis. People with psoriasis often have nail problems. Did you know that nail problems in psoriasis can sometimes be a predictor of psoriatic arthritis? There are studies that show psoriatic nail changes can be associated with arthritis, so I always check the nails of my patients with psoriasis and ask how their joints are doing. Another condition that can be seen with pitting of the nails is something called alopecia areata. This is a disease that causes the hair to fall out in patches due to cells in the immune system attacking the hair follicle.
Clubbing of the nails occurs when the fingertips appear thickened and abnormally bulbous. This can be a sign of low oxygen content in the blood which can occur in lung disease or heart failure. See your doctor if you think you have this type of nail problem.
4. Dark lines under the nails
Dark streaks under the nails are certainly worth paying attention to. In some cases, particularly when on multiple nails and in people of darker skin type, this can be a “normal variant.” If you suddenly notice a new dark streak under your nail, particularly when no other nails have dark streaks, this is a reason to see your doctor. Melanoma can be present underneath the nail and it’s very important to catch early (see my recent article on detecting melanoma). Keep in mind that people with dark skin types are at higher risk of melanoma on the hands and feet than people with a lighter skin type.
“Splinter hemorrhages” are tiny blood clots that run longitudinally along the nail bed. They literally look like tiny splinters under the nail. They commonly occur after traumatizing your nail in some way. People who type a lot may have tiny splinter hemorrhages at the tips of their nails. Sometimes, however, splinter hemorrhages can be a sign of an underlying illness. This is particularly possible when several nails are affected and when the splinters are closer to the cuticle than the tip of the nail. In this case, they may be a sign of a blood infection called “endocarditis” where bacteria in your blood stream land on the heart valve. Another condition associated with splinter hemorrhages is vasculitis, which is inflammation of your arteries which can be seen in autoimmune diseases, among other conditions. As a result, if you begin to notice these, you should definitely call your doctor.
6. Bluish nails
This is a concerning finding called “cyanosis.” Usually blue nails can represent low amounts of oxygen in the blood. In cold temperatures, you may notice that your fingernails look somewhat blue. This is because the cold temperature slows blood flow down. If your fingernails always look blue, it’s time to see your doctor. They may check your blood, heart and lungs. There is another condition called Raynaud’s which can lead to whitening of the fingers and toes which then turn blue. This can be seen in autoimmune diseases like lupus or can be seen on its own with no associated disease.
7. Spoon-shaped nails
While this is a normal finding in babies, it can be an abnormal sign in adults. “Koilonychia” is what it is actually called. In adults, it can be a sign of iron deficiency.
As you can see, nails can tell us a lot about our overall health. Weak nails can be seen with nutritional deficiencies so make sure to eat a healthy diet and keep your cuticles hydrated with moisturizer such as Dr. Bailey’s Dry Hand Cream to keep your nails strong. If you are having problems with your nails, make an appointment with our board certified dermatologists. We can help figure out what’s going on and give you tips to grow healthy, beautiful nails!
Dr. Hayes – Board Certified Dermatologist